By Pierluigi Mancini, Ph.D.Project Director, National Hispanic and Latino ATTC

We are going through a difficult period, together, and we are all going through it in our own way. What COVID-19 has done to us as a society is traumatic and the impact of untreated trauma can be subtle, insidious, or outright destructive.

The American Psychiatric Association (APA www.psychiatry.org) reported in a recent survey that almost half of Americans (48%) are anxious about the possibility of contracting coronavirus, COVID-19, that 40% are anxious to get seriously ill or die, and 62% are anxious about the possibility of family and loved ones becoming infected.

It is natural to feel stress, anxiety, anguish and worry during and after a crisis like COVID-19. Each person reacts differently, and their own feelings will change over time. You have to become aware of how you feel and accept it.

Separation from loved ones, loss of freedom, and uncertainty about the state of the disease are cause for concern. Studies have begun to show that most people in social isolation have negative psychological effects, including symptoms of post-traumatic stress, confusion, and anger. The biggest stressors include fears of infection, frustration, boredom, inadequate supplies, inadequate information, financial losses, and stigma.

Lack of connection can cause a feeling of loneliness and is especially aggravated in those recovering from addictions or mental health problems. Each one reacts differently to stressful situations. The typical reactions that occur when sheltering in place due to an immediate problem are different. Some of the emotions that we may be feeling in this situation include anxiety, fear, worry, uncertainty, frustration, sadness, boredom, fear of asking for income or work and negative effects on the ability to sleep well and eat healthy.

The fact of not being able to continue with the routine itself is a factor that disorganizes our structure since we lose the feeling of control. It is important to remember the ability we have to reorganize a new structure.

We can also go through different changes including changes in behavior such as the increase or decrease in energy and activity levels or excessive worry and even the inability to feel pleasure or have fun.

Changes in your body such as stomach pain or headaches or other discomforts or loss or increase in appetite; changes in thoughts like difficulty remembering things or feeling confused. All these symptoms can be interpreted as excuses or reasons to drink or use drugs or to give up and not want to go on.

If the madness of addiction is lived in solitude during its last stages, recovery always occurs with the help and participation of others. And for that we need to build resilience.

The concept of resilience helps to understand and promote positive development in situations originally perceived as negative and in potentially destructive challenges. It is the ability to respond to pressures and tragedies quickly, adaptively and effectively, remembering and acknowledging that experience to face future adversities. Applied to humans, resilience is the ability of an individual to develop positively despite adversity. Their goal is to come out strengthened and transformed by the experience, however painful it may be.

We can build resilience using various tools such as focusing on one's strengths, rather than weaknesses; acting on the solutions, and not on the causes of the problem; substituting rigidity for flexibility and recognizing that the past cannot be changed, but that we can learn how it is influencing our present to make the appropriate adjustments today.

For those in social isolation, the general recommendation is to establish a routine with space for leisure and exercise; stay informed through official trustworthy channels like the CDC (www.cdc.gov) and SAMHSA (www.samhsa.gov) and do not overexpose yourself to the news about the coronavirus. It is also recommended to keep in touch with family and friends. It is important to stay connected through social media, but again, with limits. Connections, even if they are virtual, are the great shock absorbers of stress.

We must trust our recovery. What we have achieved so far is worth a lot and you should not forget everything you have done to achieve it. Use your tools, just because you can't go out you don't have to forget them. And in order to relax, start with things you know that help you relax, such as deep breathing, stretching, meditating or praying, or entertaining yourself with a hobby you like.

Do things you enjoy, like reading, listening to music, exercising, or taking a bath; talk about your experience and feelings with loved ones and friends; keep hope and think positively.

And finally, if you need help, please find her. Today we have help available and you can go to www.samhsa.gov where you will find support phones and websites.

Implementation, the final phase of the ATTC Technology Transfer Model, moves an innovation into routine practice in real-world settings.

For the Great Lakes ATTC, implementing Recovery-Oriented Systems of Care in real-world settings has been a particular focus since the concept first began to take shape. (See related blog post: Building a Science of Recovery: The Pinnacle ATTC Achievement.)

SAMHSA defines a Recovery Oriented System of Care as:

“A coordinated network of community-based services and supports that is person-centered and builds on the strengths and resiliencies of individuals, families, and communities to achieve abstinence and improved health, wellness and quality of life for those with or at risk.” (SAMHSA, 2011)

The Recovery-Oriented Systems of Care Illinois State Network (ROSC-ISN)

The Great Lakes ATTC provides training and technical assistance for ROSC implementation projects throughout the six-state region at the state, county, and local levels.

One example of a statewide initiative currently underway is the Recovery-Oriented Systems of Care Illinois Statewide Network (ROSC-ISN), launched by the Illinois DHS in the fall of 2018 under the leadership of Dani Kirby, director of Substance Use Prevention and Recovery (SUPR) at IDHS. Rex Alexander, also of IDHS SUPR, serves as the project director for ROSC-ISN.

“Our technical assistance has included all of the coordination, planning, and delivery for the ROSC-ISN,” says Scott Gatzke, Great Lakes TA coordinator for the project. “This includes face-to-face meetings, one-on-one coaching calls, monthly peer learning calls, and report-out sessions where participants share lessons learned.”

The goal of ROSC-ISN to help eight local ROSC Councils throughout the state build community-based recovery supports tailored to the unique needs of the community. Each ROSC Council has a lead agency that provides leadership for the local council, with support from IDHS/SUPR.

“We are collaborating with organizations that provide substance use disorder services to identify service gaps,” explains Dantzler-Wright. “Being part of the ROSC-ISN has enabled us to reach over 13 communities on the west side of Chicago, provide information to those agencies, and collect data. This state initiative is helping our RCO to work on a system transformation.”

Adds Gatzke, “The ultimate goal of this project is to create multiple stand-alone Recovery Community Organizations in Illinois that will spin off from the ROSC Councils. The system change that emerges from this important initiative will provide valuable lessons that our Center can apply in other ROSC initiatives in our region and beyond.”

The Mid-America Addiction Technology Transfer Center (a collaboration between Truman Medical Center Behavioral Health and the University of Missouri-Kansas City School of Nursing and Health Studies) developed an intensive technical assistance manual to be used by Technology Transfer Centers to facilitate trauma informed care (TIC) implementation in substance use and recovery service settings.

The manual will provide guidance for TIC consulting teams on issues such as:

Evidence for effectiveness of TIC implementation, including improved client experience and employee well-being and retention

Key considerations for TTCs as they determine capacity and strategies to provide TIC consultation

Examples of different levels of TA activities to promote implementation

Core components of trauma-informed care and corresponding consultant and organization activities during each stage of implementation

Defining and navigating the role of a consultant in organizational change

Building and supporting organizational capacity to lead, sustain, and evaluate TIC implementation

Future considerations for TIC implementation may be developed for peer recovery coaches, CLAS standards, child welfare, and other community partners

To pilot the manual’s multi-faceted TIC implementation process, Mid-America conducted site visits to regional provider agencies expressing interest in becoming a TIC environment. Osawatomie State Hospital (OSH) in Kansas was selected as the initial pilot site; OSH leadership signed a memorandum of understanding committing the organization to weekly on-site and virtual engagements with TIC TA specialists. The OSH leadership and the TIC TA specialists will navigate through multiple steps including relationship building and program design, and movement through four stages: trauma aware, trauma sensitive, trauma responsive, and trauma informed.

Movement to a trauma informed culture requires dedication from all levels of staff, from the ground up and top down. With thorough self-evaluation through surveys and group discussions regarding individuals and the provider organization as a whole, the end goal is operating with a Trauma Informed Care lens. Once provider organizations have reached this stage, the aim is that the organization will:

Demonstrate a sustainable commitment to trauma-informed values and all employees and volunteers implement trauma-informed practices;

Other agencies and community partners turn to organization for expertise and leadership;

All staff respond to internal and external changes, barriers, and growth through a Trauma Informed lens.

A secondary goal of the project is to field-test evaluation tools, resources, tips, case studies, and step-by-step guidance for TIC consultant teams. In 2021, Mid-America plans to initiate a virtual TTC TIC Team Learning Collaborative to provide initial guidance in how to use the intensive technical assistance manual and support those regional ATTCs providing TIC consultation.

Crisis requires that we triage the most urgent matters, and take rapid action to address them.
Crisis demands that we limit our analysis to the critical data points.
Crisis demands that we try new and untested strategies, and rapidly respond to the results of our efforts.

Crisis is dangerous, chaotic, messy, heart-wrenchingly painful,…and also an opportunity for invention.

During the past several weeks you probably have:

Recognized immediate problems.

Prioritized resources.

Taken rapid action to test new strategies.

Made decisions based on key data.

Learned a lot from testing these new strategies and refined your efforts.

Put another way, you have been working your way through a challenging crisis using Plan-Do-Study-Act change cycles.

Rapid-cycle Testing: One of the Five NIATx Principles

“The fifth principle of the NIATx model is what we call rapid-cycle testing. Structured around what’s known as the PDSA (Plan-Do-Study-Act) Cycle, rapid-cycle testing is used to quickly evaluate the impact of potential changes on a given aim. In rapid-cycle testing, the executive sponsor, change leader, or team comes up with ideas for changes to test, and then tests each of those changes in quick succession for a short time on a limited test pool. During each test (a.k.a. PDSA Cycle), the team collects and analyzes data relevant to its chosen aim to determine whether the change has produced a desirable effect on performance levels. Depending on the outcome of that analysis, the team may decide to abandon the change completely and begin testing an entirely new change; adapt the change for further improvement and retest the modified version; or adopt the change, testing it again on a slightly larger scale, or in conjunction with other changes that have already proven successful in testing. In any case, the team uses the knowledge it has gained from one testing cycle to improve subsequent cycles. A new procedure is only implemented on a full scale once it has been proven in testing to yield significant improvement in regard to the project’s aim.”

A crisis like the one we are all facing right now is tailor-made for rapid-cycle PDSA change. Many of us have been using the NIATx model—perhaps without even knowing it. Right now is an excellent time to document the PDSA cycles that you have been conducting.

A few questions may help you to refine your understanding of the crisis work that you have been doing, and to document your PDSA efforts.

What did you observe through data or experience?

What did you do in response?

What was the result?

What did you learn?

You might also want to use the NIATx Change Project Form to document your recent efforts retrospectively. You can find the form and step-by-step instructions on how to conduct a PDSA Cycle on the NIATx website.

As this crisis persists, we struggle to figure it out as we go. Finding the opportunity in this unprecedented challenge is both difficult and painful. Yet, one way to find purpose and meaning moving forward is to learn everything we can from it.

Consider how rapid-cycle PDSA can teach you more about what you have done and will do, as we work our way through this together.

About our Guest Blogger

Mat Roosa was a founding member of NIATx and has been a NIATx coach for a wide range of projects. He works as a consultant in quality improvement, organizational development, and planning, evidence-based practice implementation. He also serves as a local government planner in behavioral health in New York State. His experience includes direct clinical practice in mental health and substance use services, teaching at the undergraduate and graduate levels, and human service agency administration. You can reach Mat at matroosa@gmail.com

Contributed by the Southeast ATTCDawn Tyus,DirectorPamela Woll, Product and Curriculum Development Consultant

Greetings from the makeshift offices we’ve set up in our kitchens and basements and spare bedrooms. The world outside our windows looks like a normal, pretty Spring day, but the world that lives in our hearts is going through some strange, difficult times.

We’re grateful to be able to continue to serve you from our remote outposts, but something important is missing: you. We used to be able to catch up with you at conferences, before and after sessions, and at technical assistance visits. We’re happy whenever we see your little video tile on our Zoom screens, but it doesn’t tell us how you’re doing.

In this field—this culture, really—that has dedicated our lives to the well-being, resilience, and recovery of people with substance use disorders (SUD), you’re probably carrying an extra weight in your heart. We know these times are particularly hard on people whose lives have left them wounded. For people whose SUDs are active, and people whose wounds are still raw in recovery, alcohol and drugs can look like part of the solution, rather than the big flashing hazards they really are.

If you’re a counselor, a coach, a supervisor, an administrator, or any other member of this field, you’ve probably read it in the literature and proved it in your work and your lives: The most healing thing we have going as a field is caring, trustworthy human connection with people. Pandemic disease may be the cruelest kind of disaster, because it robs us of that in-person, face-to-face human connection.

But there’s something we must never forget: This virus may be young and clever and highly contagious, but we have a lot of things it doesn’t have.

We have love—for our families and friends, for our colleagues, for our communities, for the people we serve, and for the work we do.

We have faith—in recovery, in our values, in our higher powers, in our science, in our skills, and in ourselves.

We have a field that has fought its way through loss and pain and stigma and discrimination, to bring real, lasting recovery to people who were once laid low by an illness that has killed far more people than any virus.

We have the memory of every time we watched someone make that transition into recovery—and saw a human life transformed before our eyes.

And we have the internet—for all the problems it sometimes causes, still a great tool for connection. We can use it to reach out, listen, teach, witness people’s pain, walk alongside them, and BE THERE—for them and with them.

And so, we’re learning to connect, more and more effectively, across the space between us. The many Centers in the ATTC and NIATx Networks have increased our use of face-to-face technologies and our development of resources to help agencies and individuals find the help, guidance, and education they need to stay informed, resilient, and effective in promoting wellness, health, and recovery.

The ATTC Network’s excellent webinar series on Telehealth is only one of many resources on the Network’s trove of Pandemic Response Resources (https://attcnetwork.org/centers/global-attc/pandemic-response-resources-responding-covid-19), and there has never been a better time to dip into the many free e-learning courses available through Health-eKnowledge.

So, we have a lot to say, but something is missing. In this strange, sad, and sometimes heroic world we’re living in, we’d like to hear what you’re going through. We want to know what we can do to help you survive, thrive, and come out of this difficult time stronger, more resilient, and more inspired. Please reach out to us.

We are here for you. We are dedicated to you and the people you serve. We want to connect with you—and help you connect with others—so we can all get each other through this time.

We believe in you. We’ve seen the enormous strengths you bring to your life and your work. We’ve seen the great love that drives you to keep going, even though it’s hard and it sometimes breaks your heart.

Dawn Tyus
Dawn Tyus is the Director of the Southeast Addiction Technology Transfer Center (SATTC) at Morehouse School of Medicine, located in Atlanta, Georgia. Dawn has been affiliated with Morehouse School of Medicine and SATTC for eleven years, as a Project Consultant, and was promoted to lead the team as the Project Director in 2011. As Director of ATTC, Dawn is responsible for the management, growth, and business development activities of the project, manage the day-to-day operations including implementation of the policies and programs, responsible for the professional development of staff, as well as new and innovative programs, manage approximately 10 external and internal staff members and consultants, facilitate professional development trainings for clinicians and staff, interface with collaborative partners and stakeholders on a local, federal and state level to organize strategies for statewide initiatives.

Dawn actively work with faith communities to strengthen their awareness, and build their skill set on working with individuals with mental health and substance use disorders.

Dawn is a member of ATTC CLAS Standards and Pre-Service Education Workgroup, Dawn is currently on the board of the Georgia School of Addiction Studies, and the Advisory Board for the Clark Atlanta University’s HBCU C.A. R. E. S.

Dawn has an impressive background in which she brings a wealth of experience from various perspectives. Her background spans many disciplines which include: nonprofit organizations, government, corporate, counseling services, consulting, strategic planning, group and individual coaching She received a Bachelor’s degree in Criminal Justice, and a Masters of Education degree in Community Counseling from Mercer University, and is currently completing her Doctoral degree in Counseling Studies at Capella University. Dawn is also a Licensed Professional Counselor in, the State of Georgia where she provides family, individual, and group mental health therapy.

Pamela Woll

Pamela Woll, MA, CADP is a Chicago-based author, curriculum developer, and consultant dedicated to increasing the resilience and capacity of individuals, families, communities, organizations, and systems of care. Her primary areas of focus include trauma-informed and recovery-oriented systems and services; the physiology/neurobiology of resilience, stress, and trauma; public health approaches to behavioral health and wellness; elimination of health and socioeconomic disparities; and the strengths and needs of service members, veterans, and their families. Her recent publications include Compassion Doesn’t Make You Tired: Unmasking and Addressing “Compassion Fatigue”; Addressing Stress and Trauma in Recovery-oriented Systems and Communities, and You Fit Together: Body, Mind, Resilience and Recovery, all published in 2017 by the ATTC Network Coordination Office. Many of the materials she has written are available for free download from her web site, https://sites.google.com/site/humanprioritiesorg/.

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The opinions expressed herein are the views of the authors and do not reflect the official position of the Department of Health and Human Services (DHHS), SAMHSA, CSAT or the ATTC Network. No official support or endorsement of DHHS, SAMHSA, or CSAT for the opinions of authors presented in this e-publication is intended or should be inferred.